Rockville Summer Climbing Camp ApplicationWeek 1: August 11 - 15 ____
Week 2: August 18 - 22 ____
Week 3: August 25 - 29 ____
Climber's Name: _________________________________Age:_____ Boy ___ Girl___
Address:______________________________________
_______________________________________
Phone: ___________________________
Parent information
Name: _______________________________________
__________________________________________
Work phone: _________________________ 2nd # ______________________________
Home phone: _____________________
Other phone (cell): _______________ Email: ___________________________
Other emergency contact information: ________________________________________
__________________________________________________________________
-----------------------------------------------------------------------------------------------------------
Office use only: Deposit _____ Balance Payment:______ Date:________ Waiver:_______